Specialist tissue viability services: a priority or a luxury?

During the 1980s, the number of tissue viability nurses (TVNs) rose steadily in the UK, in response to mismanagement of patients with wounds (Fletcher, 1995). Since this time, and in response to the quality agenda, the necessity of promoting a tissue viability service (TVS) that is able to meet the needs of a changing population, while being cost effective and offering interventions based on research and evidence, has grown. The drive to reduce avoidable harm in healthcare and to make efficiency savings is continuing, with TVS being one of the key areas to deliver these targets. However, across the UK we have a wide range of role descriptions and job titles, yet little clarification as to the qualifications and skills required to deliver a successful TVS. Infection control specialist nurses have a clear identity with concise role descriptions representing a range of pay bands. Arguably, this is because they are aligned with a medical specialty, whereas TV is not. The introduction of ‘Any Qualified Provider’ (Department of Health, 2011) has witnessed some services, including management of leg ulceration, being delivered by non-NHS providers at a reduced cost. So is TVS in danger of becoming more of a ‘nice thing’ rather than a priority

Preoperative skin antisepsis – it ain’t what you do but the way that you do it

In 2010, the New England Journal of Medicine published a randomized controlled trial (RCT) which reported the use of preoperative skin antisepsis using 2% chlorhexidine gluconate/70% isopropyl-alcohol (applied with a disposable, purpose-built, sponge applicator and a “scrubbing” technique), or an aqueous 10% povidone-iodine based preparation (applied as a paint), for prevention of surgical site infection (SSI)1. Thirty-nine of 409 patients in the 2% CHG/70% IPA study arm (9.5%) and 71 of 440 patients in the 10% PVP-I study arm (16.1%) developed an SSI after clean and clean-contaminated abdominal procedures (RR = 0.59; 95% CI: 0.41 – 0.85; P=0.004)

Forced-air warming: a source of airborne contamination in the operating room?

Forced-air-warming (FAW) is an effective and widely used means for maintaining surgical normothermia, but FAW also has the potential to generate and mobilize airborne contamination in the operating room

Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-Heal Chronic Venous Leg Ulcers

Aim To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). Background Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial. Methods A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: ‘Healed ulcer’, ‘Healing ulcer’ or ‘No improvement’ were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. A data set from a recent meta-analysis, based on four RCTs, was applied to the model. Results Treatment with silver dressings for an initial four weeks was found to give a total cost saving (£141.57) compared with treatment with non-silver dressings. In addition, patients treated with silver dressings had a faster wound closure compared with those who had been treated with non-silver dressings. Conclusion The use of silver dressings improves healing time and can lead to overall cost savings. These results can be used to guide healthcare decision makers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronic VLUs

Using QFD As A Method To Develop Functional Medical Products For Children With Cancer.

Quality Function Deployment (QFD) is a recognised method of translating customer needs into appropriate technical requirements to inform ergonomic design development. This paper details how QFD has been used to develop a tactile advanced product for a medical application. The project has undertaken innovative experimental and industrial research which has led to the design of a child-focused “Wiggle Bag” which will be used to safely harness and reduce infection at the site of a venous catheter placed in the chest wall of long-term child cancer sufferers. Children with cancer regularly have long term central venous catheters inserted through their upper chest wall to deliver medication. They can result in medical issues, particularly infections or accidental removal, but also discomfort for the children, particularly when sleeping. The research uses an inductive approach, triangulating various research strategies including questionnaires, focus groups and interviews from parents, carers and medical personnel. QFD was used to bring together the key findings from the primary data analysis to establish design criteria and inform the product development. The outcome of the research was a functional product ergonomically designed for maximum comfort and safety, with the added unique selling point of having antibacterial properties

Improving everyday life experiences for young children with cancer

Children with cancer regularly have long term central line catheters inserted in the chest to deliver medication. Often termed ‘Hickman Lines’, they result in tubing protruding from the chest, which can result in medical issues including infections, but also discomfort for the child, particularly when sleeping. A team of researchers, led by Dr Jess Power, including Professor David Leaper and Joanne Marie Harris, has been investigating the design and development of a product to contain these external lines, providing greater comfort and safety for the child whilst also meeting the needs of the medical communit

Bacterial Growth Kinetics under a Novel Flexible Methacrylate Dressing Serving as a Drug Delivery Vehicle for Antiseptics

A flexible methacrylate powder dressing (Altrazeal®) transforms into a wound contour conforming matrix once in contact with wound exudate. We hypothesised that it may also serve as a drug delivery vehicle for antiseptics. The antimicrobial efficacy and influence on bacterial growth kinetics in combination with three antiseptics was investigated in an in vitro porcine wound model. Standardized in vitro wounds were contaminated with Staphylococcus aureus (MRSA; ATCC 33591) and divided into six groups: no dressing (negative control), methacrylate dressing alone, and combinations with application of 0.02% Polyhexamethylene Biguanide (PHMB), 0.4% PHMB, 0.1% PHMB + 0.1% betaine, 7.7 mg/mL Povidone-iodine (PVP-iodine), and 0.1% Octenidine-dihydrochloride (OCT) + 2% phenoxyethanol. Bacterial load per gram tissue was measured over five days. The highest reduction was observed with PVP-iodine at 24 h to log10 1.43 cfu/g, followed by OCT at 48 h to log10 2.41 cfu/g. Whilst 0.02% PHMB resulted in a stable bacterial load over 120 h to log10 4.00 cfu/g over 120 h, 0.1% PHMB + 0.1% betaine inhibited growth during the first 48 h, with slightly increasing bacterial numbers up to log10 5.38 cfu/g at 120 h. These results indicate that this flexible methacrylate dressing can be loaded with various antiseptics serving as drug delivery system. Depending on the selected combination, an individually shaped and controlled antibacterial effect may be achieved using the same type of wound dressing

Can the design of glove dispensing boxes influence glove contamination?

Background Few studies have explored the microbial contamination of glove boxes in clinical settings. The objective of this observational study was to investigate whether a new glove packaging system in which gloves are dispensed one by one vertically with the cuff-end first has lower levels of contamination on the gloves and on the surface around the box aperture compared to conventional horizontally dispensed glove boxes. Methods Seven participating sites were provided with vertical glove dispensing systems and conventional boxes. Before opening boxes, the surface around the aperture was sampled microbiologically to establish base-line levels of superficial contamination. Once the boxes were opened, the first pair of gloves in each box were sampled for viable bacteria. Thereafter, testing sites were visited on a weekly basis over a period of six weeks and the same microbiological assessments made. Results The surface surrounding the aperture of the modified dispenser boxes became significantly less contaminated than the conventional boxes (P < 0.001) with an average of 46.7% less contamination around the aperture. Overall, gloves from modified boxes showed significantly less colony-forming units contamination than gloves from conventional boxes (P < 0.001). Comparing all sites over the entire six-week period, modified dispensed gloves had 88.9% less bacterial contamination. Conclusion This simple improvement to glove box design reduces contamination of unused gloves. Such modifications could decrease the risk of microbial cross-transmission in settings that utilise gloves. However, such advantages do not substitute for strict hand-hygiene compliance and appropriate use of non-sterile, single-use gloves

Surveillance of surgical site infection: more accurate definitions and more intensive recordings needed

Surgical site infection (SSI) continues to be a burden on systems that deliver healthcare and on patients who suffer morbidity, and mortality, associated with this complication of medical intervention. Surveillance of SSI is often an integral part of organizational infection prevention and control activities, but unless post-discharge surveillance is carried out in a robust manner the data may be inaccurate and misleading. Coupled with a lack of robust application of definitions, variations in methods of case-finding and incomplete follow-up, the results may lead to a false sense of security or conversely cause unnecessary anxieties. Data from national surveillance schemes that purport to be suitable for benchmarking are often at odds with published rates from well-designed studies and the reasons for this should be examined. If benchmarking is truly desirable and if clinicians are to have confidence in the outputs, surveillance schemes should ensure that participating organizations adopt a consistent approach to definitions, case-finding methodologies following discharge, and to robust follow-up, to ensure that every opportunity is taken to maximize the return rate and enhance data validity